治療前後の小腸病変を形態学的に詳細に評価しえたサイトメガロウイルス腸炎の1例

Small Intestinal Lesions Associated with Cytomegalovirus Enterocolitis Diagnosed by Detailed Image Assessment, Report of a Case

要旨　患者は70歳代，女性．高血圧，糖尿病の診断で近医に通院中であった．下痢，腹痛の出現の後，意識障害も認めたため当院へ緊急入院となった．感染性腸炎を契機とした高血糖，糖尿病性昏睡と診断し，インスリン療法，抗菌薬にて加療を行った．しかし，腹痛，下痢は持続したため精査を行ったところ，下部消化管内視鏡検査にて，盲腸とS状結腸に巨大な潰瘍を認めた．サイトメガロウイルス（CMV）antigenemia陽性で，大腸潰瘍からの生検でもCMVの存在が確認され，CMV腸炎と診断した．他臓器検索目的で，小腸X線造影検査を行ったところ，小腸にも多発潰瘍を認め，その後に行ったカプセル内視鏡検査，ダブルバルーン内視鏡検査では全周性，帯状，輪状と多彩な形態を呈した潰瘍がほぼ全小腸に多発していた．ガンシクロビル投与にて，穿孔などの重篤な合併症なく，症状は改善した．CMV腸炎の小腸病変を詳細に画像評価しえた報告はまれであり，貴重な症例と考え報告した．

　A 77-year-old woman receiving ambulatory care at another hospital for hypertension and diabetes mellitus was transferred to our facility for treatment of diarrhea, abdominal pain, and consciousness disturbance. We diagnosed hyperglycemia and diabetic coma as well as infectious enteritis. A treatment regimen of antibiotics and insulin was initiated but her abdominal pain and diarrhea persisted. Furthermore, we performed lower endoscopy, which revealed large ulcers in the sigmoid colon. Biopsy samples from these ulcers tested positive for CMV（cytomegalovirus）antigen, leading to a diagnosis of CMV colitis. Radiographic imaging revealed multiple ulcers around the small intestine. Capsule endoscopy and double-balloon enteroscopy showed ulcers around the entire circumference of the middle small intestine, including band-like ulcers. Symptoms improved after administration of ganciclovir and no severe complications, such as perforation, occurred. Here we report a rare of case small intestinal lesions associated with CMV colitis diagnosed by detailed image assessment.